使用Mitomycin C膀胱熱化療治療中及高風險非肌肉侵犯膀胱癌
賴宗豪1、溫玉清1,2、李良明1、林克勳1,2、林雍偉1,2、蕭志豪1、石宏仁1
1臺北市立萬芳醫院 泌尿科；2臺北醫學大學 醫學院 泌尿學科
Intravesical chemohyperthermia with Mitomycin C for intermediate- & high-risk non-muscle invasive bladder cancer
Chung-Howe Lai1, Yu-Ching Wen1,2, Liang-Ming Lee1, Ke-Hsun Lin1,2, Yung-Wei Lin1,2, Chi-Hao Hsiao1, Hung-Jen Shih1
1 Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
2 Department of Urology, School of Medicine, College of Medicine, Taipei Medical University
Purpose:
Compare the efficiency of intravesical chemohyperthermia(CHT) versus intravesical Mitomycin-C (MMC) alone in intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) patients.
Materials and Methods:
Between 1st January 2016 and 30th September 2018, 53 NMIBC patients were collected. Patients with intermediate- or high- recurrence risk according to the European Organisation for Research and Treatment of Cancer (EORTC) stratification were eligible. Patients were divided into 2 groups, one treated with intravesical chemohyperthermia(CHT): External deep pelvic hyperthermia (using a BSD-2000 device) combined with MMC 30 mg. Bladders were heated to 41oC for 1 hour during intravesical MMC, weekly for 5 courses, followed by monthly MMC maintenance sessions for a total of one year; The control group was treated with intravesical MMC alone: MMC 30 mg weekly for 6 courses, followed by monthly MMC maintenance sessions for a total of one year. Recurrence and progression rates at 12 months were assessed.
Results:
A total of 47 patients were enrolled; 22 patients in the CHT arm versus 25 in the control arm. EORTC recurrence and progression risk were mostly intermediate in both arms. Median follow-up time was about 24 months. The 12-mo recurrence rate in the CHT arm was 9.1% (2/22) vs 28% (7/25) in the control arm. The 12-mo progression rate was 4.5% (1/22) vs 4% (1/25) in the control group. No death was noted in the CHT arm, whereas only 1 (4%) patient in the control arm died due to pneumonia with respiratory failure. Adverse events were all minor (grade 2 or less) and no systemic toxicity was observed. The most common adverse effects in the CHT arm were frequency, abdominal discomfort, chemical cystitis symptoms, and abdominal skin swelling.
Conclusion:
CHT is a safe and effective treatment option for intermediate- and high-risk NMIBC patients, offering a significantly decreased recurrence rate, compared to intravesical MMC alone.